Heart and Vascular Institute, Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
Catheter Cardiovasc Interv. 2021 May 1;97(6):1252-1256. doi: 10.1002/ccd.29310. Epub 2020 Oct 5.
Despite the rising use of MC, the impact of preexisting AF, a common comorbidity, on short-term postprocedural outcomes is poorly defined. We sought to assess outcomes between patients with and without atrial fibrillation (AF) who underwent percutaneous mitral valve repair with MitraClip (MC).
In this retrospective cohort study, the Nationwide Readmissions Database was queried for patients who underwent MC between 2014-2017. Groups were stratified based on the presence of AF. Multivariable logistic regression analyses were performed to identify the association between AF and in-hospital stroke and mortality.
Of the 15,570 patients who underwent MC, 7,740 (49.7%) had AF. AF patients were older (82 vs. 79 years, p < .001) and more comorbid. Patients with AF relative to without AF demonstrated increased rates of in-hospital ischemic (1.3% vs .0.7%, p < .001) and hemorrhagic stroke (0.3% vs. 0.1%, p = .007), longer duration of hospitalization (median 3 vs. 2 days, p < .001), and similar in-hospital mortality (2.8% vs. 2.6%, p = .52). After adjusting for comorbidities, age, sex, hospital procedural volume, and CHA2DS2-VASc, the presence of AF was associated with higher in-hospital stroke (OR = 2.096, 95%CI[1.503-2.921], p < .001) but not in-hospital mortality (OR = 1.012, 95%CI[0.828-1.238], p = .904). AF patients were more likely to be readmitted (16.8% vs.14.1%, p < .001) and die (1.5% vs. 0.9%, p = .005) within 30 days of discharge despite similar incidences of stroke (0.7% vs. 0.6%, p = .53).
The increased risk of in-hospital stroke, 30-day mortality, and longer hospitalization suggest the need for increased preprocedural optimization by means of stroke prevention strategies in those with AF undergoing MC.
尽管经导管二尖瓣修复术（MC）的应用日益增多，但常见合并症——心房颤动（AF）对短期术后结局的影响仍不明确。本研究旨在评估接受 MitraClip（MC）治疗的伴有和不伴有心房颤动（AF）的患者之间的结局。
本回顾性队列研究使用全国再入院数据库，检索了 2014 年至 2017 年间接受 MC 治疗的患者。根据是否存在 AF 将患者分为两组。采用多变量逻辑回归分析确定 AF 与住院期间卒中及死亡之间的关系。
在 15570 例行 MC 的患者中，7740 例（49.7%）患有 AF。与无 AF 患者相比，AF 患者年龄更大（82 岁 vs. 79 岁，p<0.001）且合并症更多。与无 AF 患者相比，AF 患者的住院期间缺血性（1.3% vs. 0.7%，p<0.001）和出血性卒中（0.3% vs. 0.1%，p=0.007）发生率更高、住院时间更长（中位数 3 天 vs. 2 天，p<0.001）、住院期间死亡率相似（2.8% vs. 2.6%，p=0.52）。在校正合并症、年龄、性别、医院手术量和 CHA2DS2-VASc 评分后，AF 与住院期间卒中（比值比[OR]：2.096，95%置信区间[CI]：1.503-2.921，p<0.001）但与住院期间死亡率（OR：1.012，95%CI：0.828-1.238，p=0.904）无关。尽管卒中发生率相似（0.7% vs. 0.6%，p=0.53），但 AF 患者出院后 30 天内再入院（16.8% vs. 14.1%，p<0.001）和死亡（1.5% vs. 0.9%，p=0.005）的风险更高。
AF 患者住院期间卒中风险增加、30 天死亡率增加和住院时间延长提示，对于接受 MC 治疗的 AF 患者，需要通过卒中预防策略进行更多的术前优化。
